No one is exempt from experiencing highs and lows in life. It is important to note, however, that bipolar disorders are much more than just a temporary feeling of being on top of the world or feeling depressed. Mental illness causes extreme mood swings that can threaten a person’s safety and well-being and leave them feeling unstable and isolated.
The World Health Organization (WHO) estimates that 60 million people worldwide have bipolar disorder. The number of people affected in the U.S. varies. About 4 percent of U.S. adults have bipolar disorder, according to a Harvard Health Publishing report in March 2019. With a broader definition, that number could be higher.
Almost anyone can develop bipolar 1 disorder. Most people who develop the disorder are in their teens or early 20s when symptoms first appear, and most develop it before age 50. Nearly 6 million Americans have bipolar disorder, about 2.5% of the population.
Bipolar disorder must be detected early enough to be treated, according to a study published in June 2019. People with their first manic episode can receive better treatment soon after they’ve had their first episode, according to the study.
Without treatment, bipolar disorder can lead to:
- Poor job or school performance
- Legal problems
- Self-harm or harm to others
- Financial worries
- Substance use disorders (SUDs)
- Strained relationships
- Suicide or attempts at suicide
What is the difference between bipolar disorder-related diagnoses? How can the disorder be treated? Learn more about bipolar disorder and the difference between bipolar 1 and bipolar 2.
What Is Bipolar Disorder?
An individual with bipolar disorder experiences unusual changes in mood, energy, activity levels, and day-to-day functioning. The condition is also known as manic-depressive illness or manic-depressive disorder.
It is possible to feel “blue” or “down in the dumps” during one phase of bipolar disorder and happy, energetic, and dynamic in the next. You might experience dramatic mood swings that can impair thinking and reasoning, cause risky behavior, and lead to suicidal tendencies.
Bipolar disorder can be treated with therapy and medication. Despite bipolar disorder being a lifelong condition, people can lead healthy lives when properly diagnosed and treated.
Types of Bipolar Disorder
There are two major types of bipolar disorder, and other disorders are very similar to bipolar disorders but involve less severe symptoms. The disorder you experience can significantly impact your symptoms and experience with the disease. Bipolar disorder symptoms can point to one of these four basic types:
Bipolar I Disorder
If you have bipolar disorder and you experience a manic episode, you have bipolar 1. Manic episodes last for at least seven days. An episode of manic depression is characterized by abnormally elevated moods and a high level of energy that disrupts daily life. In the course of an episode, manic symptoms and behaviors are present most of the time.
A person experiencing manic symptoms may need immediate hospital care if symptoms are severe. Severe mania can sometimes cause delusional thinking and psychosis. They are protected in this setting from harming themselves or others (though it is not a common consequence of the disorder for someone with bipolar disorder to be a harm to other people). Bipolar I disorder can cause a person to struggle with working and/or socializing with others, and they may also experience psychosis.
In many cases, a person in a manic phase doesn’t notice they are experiencing mania until it has worn off. While mania sometimes feels good in the moment, it can cause hasty decision-making and erratic behavior that leads to regrets and embarrassment later.
There is a possibility of manic and depressive symptoms occurring together when you have bipolar 1.
Bipolar II Disorder
Bipolar disorder of this type is more prevalent. Bipolar II mood swings can cause a person to experience highs and lows, similar to bipolar I disorder. Bipolar II disorder, however, does not produce true manic episodes. Rather, you may experience hypomania, a milder form of mania that causes fewer or less intense symptoms. Bipolar II also includes at least one major depressive episode.
However, hypomanic episodes can progress into full manias that affect a person’s ability to function. Depression is more prevalent in people with bipolar II disorder. Depressive episodes can occur between hypomania periods or after hypomania periods end. Hypomania and depression are sometimes intertwined in some people.
Furthermore, some people can maintain normal moods between episodes for a long time. If left untreated, episodes can come and go for several months. Identifying this type of bipolar disorder can be difficult since full-blown manic episodes are not the norm. When someone appears happy and carrying on as usual, unhealthy behaviors can go unnoticed for a long time. People may only begin to notice a shift when their moods are extreme, or their behavior is out of control.
It is also essential to note that bipolar II disorder is a different diagnosis from bipolar I disorder. People with bipolar II disorder may have longer periods of depression than those with bipolar I disorder, which can result in significant impairment. Even though bipolar II disorder involves less severe manic episodes than bipolar I disorder, it is still serious.
Cyclothymic disorder or cyclothymia involves periods of high and low moods like bipolar disorder, but you may never meet the criteria for either a major depressive episode or a manic episode. For that reason, you cannot be diagnosed with bipolar disorder. Still, you may experience hypomania and depressive symptoms that impair your enjoyment and functioning in life.
In adults, the symptoms must last at least two years, and in children and adolescents, they must last at least a year.
Other Specified and Unspecified Bipolar and Related Disorders
Several other mental health issues are related to bipolar disorder, including:
- Rapid cycling bipolar
- Bipolar with mixed features
- Bipolar with seasonal pattern
- Unspecified bipolar
What Causes Bipolar Disorder?
Bipolar disorder’s exact cause is unknown, but researchers continue to explore the factors that can lead to the condition. Genetics may play a significant role in the development of bipolar disorder, but it’s likely caused by a combination of factors that also include environmental and developmental causes. First-degree relatives, such as parents or siblings, can develop the disease.
It is possible that biological differences are to blame. There seems to be a physical change in the structure of the brain in individuals with this disorder. Stressful or traumatic events and substance abuse could also contribute to an increased risk of developing bipolar disorder.
Signs and Symptoms of Bipolar Disorder
Mania, hypomania, and depression are the three main symptoms of bipolar disorder. If you have any of these symptoms, you may need to consult a doctor. Other symptoms may include the following.
Manic episodes are characterized by the following symptoms:
- Increased energy or agitation
- Anger, restlessness, or irritability
- Less need for sleep or an inability to sleep
- Strong feelings of enthusiasm, happiness, or excitement
- Rapid or racing thoughts
- Rambling speech that doesn’t make sense or is hard to understand
- Increased risk-taking or reckless behavior
- Fast-talking or talking more than usual; loud speech
- Inflated self-esteem
- Excessive spending
- Pleasure-seeking behaviors, such as increased interest in sex, alcohol, and drugs
During a manic episode, some people find it difficult to remain calm or think rationally.
A hypomania episode may present with a combination of symptoms similar to those of a manic episode. However, you may experience fewer or more mild symptoms. These include:
- Decreased need for sleep or an inability to sleep
- Increased energy or agitation
- Appetite changes
- Rapid, racing thoughts
- Increased risk-taking or reckless behavior
- Talking rapidly or talking more or louder than usual
The symptoms described above must be present for at least four days during a true hypomanic episode. When experiencing these symptoms, a person may think everything is normal, but their loved ones may notice a change in their behavior.
Often, manic or hypomanic states are followed by depressive states. An episode of major depression may present with the following symptoms:
- Decreased energy
- Feeling sad, empty, hopeless, or worthless
- Withdrawing from others, becoming isolated
- Weight gain or weight loss without dieting
- Suicidal thoughts or tendencies
- Concentration difficulties
- Showing no interest in usual activities or hobbies
- Having trouble falling asleep, staying asleep, or sleeping too much
Manic episodes can be hard to manage after the euphoria has worn off. Anxiety and melancholy are symptoms of hypomania and major depression. It is common for people with bipolar II disorder to cycle rapidly between these two states.
For people who do not know they have bipolar disorder or have not been diagnosed or received the treatment they require, this cycle of mood swings and other emotional ups (manic episodes) and downs (depressive episodes) can be confusing.
It’s important to consult a doctor about your concerns if you or a loved one have experienced episodes of mania, hypomania, or depression. During this visit, you may receive an evaluation that can assist you in finding answers.
If you suspect you might have bipolar disorder, an evaluation with a doctor can include the following:
A Physical Exam and Lab Tests
As with many mental health issues, no physical exam can definitively diagnose bipolar disorder. However, it’s important to investigate potential medical causes for mental health symptoms.
A physical exam and blood tests can rule out other illnesses that cause symptoms that may be similar to bipolar disorder.
A Psychiatric Assessment
Psychiatrists can discuss patterns of your thoughts, feelings, and behaviors to explore the potential causes of your mental health symptoms. They will likely use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to guide their diagnosis. During this step, you may be asked to fill out psychological assessments or questionnaires. But you may also go through a biopsychosocial assessment with a clinician. This questionnaire, which takes about an hour to complete, explores your biological, psychological, and sociological symptoms, needs, and concerns.
You can chart your moods, sleep patterns, and other factors every day using mood charts. Keeping track of your moods and symptoms over time can be helpful in getting an accurate diagnosis.
What Does Bipolar Disorder Treatment Look Like?
Bipolar disorder can be treated in all its forms. The purpose of these treatments is to help people manage the symptoms of the disorder so they can function daily. Depending on the person requiring treatment, the treatment approach for bipolar disorder will vary. Treatments for bipolar disorder include medication, day treatment programs, substance abuse treatment, and hospitalization.
Psychological counseling (psychotherapy) can also be used as a primary treatment for bipolar disorder. Education and support groups may also be helpful.
Bipolar disorder treatment can involve various medications. Depending on the person’s symptoms, the medication prescribed will vary. The medication should be started immediately and taken as directed since these drugs help to balance their mood.
It can take a while to figure out which medication works best for you. Choosing the right combination of medications can take weeks or months, so it’s important to be patient and communicate with your doctor throughout the process. It is possible to adjust medications as symptoms change. If you experience side effects that concern you, speak with your physician or mental health care professional.
If you have taken medication for a period of time, you should not stop taking it or change it without speaking to your doctor. Drug withdrawal effects can worsen your condition if you suddenly stop using the drug. Depression, suicidal thoughts or manic or hypomanic episodes may occur. Consult your doctor if you think that something needs to be changed.
Common bipolar medications can include:
- Mood stabilizers. Manic and hypomanic episodes can be controlled with these medications. Lithobid and lamotrigine, among others, are examples of mood stabilizers.
- Antipsychotics. Severe depression and mania, as well as psychotic symptoms, are treated with antipsychotic medicines. Mood stabilizers can be prescribed along with these medications. Seroquel and aripiprazole are examples of antipsychotics.
- Antidepressants. Depression symptoms can be managed with the help of these medications. Manic episodes can be triggered by them, so they may be prescribed along with mood stabilizers or antipsychotics.
- Antidepressant-antipsychotic. This combination drug consists of antidepressant fluoxetine and antipsychotic olanzapine. This can be used to treat depression that is associated with psychotic symptoms.
- Anti-anxiety medications. Ativan (lorazepam) and Xanax (alprazolam) may also be used as part of the treatment plan. Prescriptions for these medications are likely to be used short-term to manage anxiety.
Bipolar disorder treatment also includes psychotherapy in many cases. Individual, family, and group sessions are common forms of psychotherapy. Some common therapies used to treat bipolar disorder include:
- Psychoeducation. Bipolar disorder requires patience and time to understand. It is important that everyone involved in the treatment process understands the disorder so that they can give and receive support and use strategies to prevent relapse.
- Cognitive behavioral therapy (CBT). The goal of this therapy is to help people identify unhealthy behaviors and beliefs and learn to replace them with healthier ones. As a result, people will be better aligned with their short and long-term goals. As well as helping people identify and manage their stress, CBT can also give them a better understanding of what triggers their bipolar episodes.
- Interpersonal and social rhythm therapy (IPSRT). In IPSRT, the rhythms of a patient’s daily routine are stabilized, including when they sleep, wake, and eat. It is easier to manage your mood when you have a consistent routine. Sleeping, eating, and exercising on a regular basis can be beneficial.
- Family-centered therapy. Family members of someone with bipolar disorder can learn how best to support and communicate with their loved ones through this type of therapy. Everyone can learn how to recognize mood swing warning signs and how to deal with them. Treatment plans can also encourage the person with the disorder to stay committed.
A medical treatment option for severe major depression is electroconvulsive therapy (ECT). Patients with bipolar disorder are commonly treated with this option when other approaches, such as medication and psychotherapy, are ineffective.
A healthcare provider uses controlled electric shocks to cause seizures in certain parts of the brain to help regulate the patient’s mood. A trained medical professional monitors the patient who receives the treatment while under anesthesia. Anesthesia is provided by a physician assistant, a nurse, and a psychiatrist.
Anxiety and depression can also be treated with exercise, as previously mentioned. However, before beginning an exercise program, talk to your doctor.